Medicare reimburses in-hospital costs based on a set payment for a diagnostic related group (DRG). This means the hospital is reimbursed for a fixed amount based on the diagnosis and projected cost for care
As a result of this system the hospital can make a profit or a loss. Select the responses that describe when a profit for care of the client can be achieved.
A) All of the hospitalization charges are less than projected.
B) The client receives incompatible blood so the hospital does not get charged for it.
C) The client is discharged before the approved discharge date.
D) The nursing care results in the client reaching outcomes for recovery, without complication, after the projected timetable.
Ans: A, C
The hospital will make a profit when cost of hospitalization is less than the reimbursement assigned for the severity of illness and projected care costs. If the client is discharged earlier than projected the hospital keeps the total reimbursed. Incompatible blood is a preventable error, for which the hospital is not reimbursed. Reaching outcomes after the approved time results in additional cost to the hospital.
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